by Liz Szabo, USA TODAY

by Liz Szabo, USA TODAY

Country singer Mindy McCready, whose troubled personal life often overshadowed her music, made several suicide attempts using pills in the past decade. She died this time when she used a gun.

The role of guns in suicide is receiving renewed attention in the national debate over firearms violence after the shootings in Newtown, Conn. About 19,000 of the more than 31,000 gun-related deaths in the USA each year are due to suicide - far outnumbering gun-related homicides.

While guns are involved in just 5.6% of suicide attempts, they account for 55% of suicide fatalities. That's because 85% of suicide attempts involving guns result in death, making firearms the leading method of suicide in the USA, according to the Centers for Disease Control and Prevention. In comparison, taking pills results in death in 2% of cases.

"It's access to weaponry that turns desperate people into suicides," says psychiatrist Kenneth Duckworth, medical director for the National Alliance on Mental Illness, interviewed before McCready's death.

McCready, 37, died in her Arkansas home Sunday of an apparent self-inflicted gunshot wound. McCready, who had attempted suicide in 2006 and 2008, went into rehab last month after her boyfriend, record producer David Wilson, fatally shot himself.

People are at higher risk of suicide if one of their loved ones has committed suicide.

McCready had a number of run-ins with the law in the past decade, including arrests for buying painkillers with a fake prescription, among other offenses.

Though the loved ones of those who commit suicide often wonder why someone might want to die, mental health professionals trying to prevent suicide say it's more important to examine how the person tried to do it.

Doctors at the Harvard School of Public Health have launched a program called "Means Matter" (meansmatter.org) to educate people about the role of guns in suicide.

Though women are much more likely to attempt suicide, men die more often from suicide, largely because they use guns, Duckworth says.

The National Rifle Association has said guns don't play a major role in suicide, arguing that suicidal people will always find a way to kill themselves.

The facts don't bear that out, says Catherine Barber, who directs the Means Matter Campaign at the Harvard School of Public Health's Injury Control Research Center.

Many people who attempt suicide do so with little planning, during a short-term crisis, Barber says. Though long-term depression and substance abuse can play a role, the "acute period" of high suicide risk often lasts only minutes or hours.

A 2005 study found that, among people who had survived a suicide attempt, one in four deliberated for less than five minutes. Nine in 10 people who survive a suicide attempt don't later die of suicide, according to the Harvard center.

"Someone who wants to hang himself can change his mind," says Liza Gold, a forensic psychiatrist at the Georgetown University School of Medicine in Washington, D.C. "With a gun, it only takes an instant, and you can't take it back."

Many studies show that reducing access to lethal methods dramatically lowers the rate of suicide, Barber says.

For example, suicide rates fell in the United Kingdom after that country eliminated carbon monoxide from home cooking gas, which had been the most common form of suicide in the 1950s. A 2002 study estimates that, over a 10-year period, that change saved up to 7,000 lives.

Suicide rates in the U.K. also fell after the country took action to make it harder to deliberately overdose on a common painkiller, says Paul Appelbaum, a professor of psychiatry, medicine and law at the Columbia University College of Physicians & Surgeons in New York. Manufacturers limited the number of pills per package and began packing pills in blister packs, rather than loose in bottles.

The risk of suicide is three times higher in households with guns compared with those without guns, according to a 1993 study published in The New England Journal of Medicine.

Suicide rates are higher in rural areas, not because people who live in the country are more depressed, but because they're more likely to own guns, Barber says.

Families of people who are depressed, or who have a history of suicidal thinking, can help protect their loved ones by encouraging people to get guns out of the home, Gold says. Gold says she frequently asks her depressed patients if they have guns, and if so, how many.

"Absolutely, you need to talk to people about guns," Gold says. "I try to get the family on board. I say, 'Can you take the guns to another location, or put them in a gun safe? Can you lock up the guns and keep the key?'"

Tom Morton, a reporter at the Casper Star-Tribune in Wyoming, wrote a column in 2011 about his decision to voluntarily get rid of a rifle inherited from his father.

"I've had a long-running battle with depression that has included a suicide attempt with pills and alcohol," Morton wrote. "If I had a gun, I wouldn't be here."